Drug Reference

Frequently Asked Questions About Esophageal Cancer

Here are some answers to frequently asked questions about esophageal cancer.

Q: What is the esophagus?

A: The esophagus is a muscular tube. It is part of the digestive tract.

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The esophagus is about 10 inches long and connects the throat to the stomach. It is behind the windpipe and the main artery from the heart (the aorta) and in front of the spine. During swallowing, the esophagus tightens and contracts, causing "waves" to push food down into the stomach. Glands in the esophagus make mucus to keep the tube moist and make swallowing easier.

Q: What is esophageal cancer?

A: Cancer occurs when cells grow out of control. Esophageal cancer is when cells grow out of control in the esophagus, the tube that carries food and liquid from the mouth to the stomach. Cancer can develop in any part of the esophagus. It typically begins in the inner lining and may spread along and into the esophagus wall. If it spreads, it usually shows up first in the lymph nodes, the windpipe (trachea), and the large blood vessels in the chest. Then it may spread into other parts of the body, such as the lungs, liver, or stomach.

Q: What are the different types of esophageal cancer?

A: There are two main types of esophageal cancer--adenocarcinoma and squamous cell:

Adenocarcinoma. This occurs in the gland cells, which are also called adenoid cells. These cells make mucus and other fluids. They are usually found in the stomach, but can move up into the lower part of the esophagus, replacing squamous cells. This type of esophageal cancer is more common than squamous cell carcinoma.

Squamous cell carcinoma. This is cancer that begins in the flat cells of the esophagus. These cells line the entire esophagus. Less than half of all cancers in the esophagus begin in the squamous cells.

Q: What is Barrett's esophagus?

A: Sometimes fluid from the stomach backs up into the lower esophagus. This is called reflux or gastroesophageal reflux disease (GERD). Over time, the reflux may cause the cells in the lower esophagus to change. This condition is called Barrett's esophagus. In some cases, Barrett's esophagus leads to esophageal cancer.

Q: What are the risk factors for esophageal cancer?

A: Certain factors can make one person more likely to get esophageal cancer than another person. These are called risk factors. Smoking and drinking alcohol are the two biggest known risk factors for this type of cancer. Doing both of them puts you at highest risk for esophageal cancer. Other risk factors include being older than 55, being a man, being obese, and having reflux or Barrett's esophagus.

Q: What are the symptoms of esophageal cancer?

A: Often, there are no symptoms in the early stages of esophageal cancer. Symptoms might not appear until the disease is more advanced. Early symptoms often feel like indigestion or heartburn, so many people ignore those symptoms. The most common symptom is trouble swallowing. At first, the trouble is with dry, solid foods such as bread, muffins, or chicken. It can become hard to swallow liquids. You may also feel pressure or burning when swallowing. You may feel like food is stuck in your throat or chest. You might lose weight without trying because you're eating less. Other symptoms can include choking, vomiting, coughing, hoarseness, and pain in the throat or breastbone. You may notice a lump on your neck or collarbone, or under your arm.

Q: How is esophageal cancer diagnosed?

A: To make a diagnosis, the doctor asks questions about your medical history, family history, and risk factors. The doctor will also do a physical exam to check for signs of the disease. To view your esophagus, the doctor may order either or both of these tests:

Barium swallow. A special X-ray test where a doctor watches you swallow a liquid.

Upper endoscopy. A test where a doctor places a small, narrow camera into your esophagus.

During the endoscopy, the doctor can take a sample of any unusual tissue called a biopsy. The sample can be checked for cancer cells.

Q: Should everyone get a second opinion for esophageal cancer?

A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion:

Not feeling comfortable with the treatment decision

Being diagnosed with a rare type of cancer

Having several options for how to treat the cancer

Not being able to see a cancer expert

Many people have a hard time deciding which treatment to have. It may help to have a second doctor review the diagnosis and treatment options before starting treatment. A short delay in treatment usually will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Many other companies will pay for a second opinion if asked.

Q: How can someone get a second opinion for esophageal cancer?

A: There are many ways to get a second opinion:

Ask a primary care doctor. He or she may be able to suggest a specialist. This may be a surgeon, gastroenterologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.

Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and programs supported by the National Cancer Institute

Seek other options. Check with a local medical society, a nearby hospital or medical school, or a support group to get names of doctors who can give you a second opinion. Or ask other people who've had esophageal cancer for their recommendations.

Q: How is esophageal cancer treated?

A: Surgery is the most common treatment. The goal is to take out the tumor. If that isn't possible, then the goal is to ease symptoms These are some other treatments that are used:

Radiation therapy

Chemotherapy

Photodynamic therapy (PDT) and other laser therapies

Radiation therapy and chemotherapy may be done to shrink the tumor, either before or instead of surgery, or to kill any cancer cells that are left after surgery. Many of these treatments may be used together. For instance, chemotherapy may make radiation and laser therapies, including PDT, more effective. The choice of treatment depends on how much the cancer has spread and the person's overall health and personal preferences.

Q: What are clinical trials?

A: Clinical trials are studies of new kinds of treatments. Some trials are specific to cancer. Doctors and nurses do clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People in clinical trials may get a treatment before the FDA has approved it. Joining a trial helps researchers learn more about cancer and how to help future cancer patients. Clinical trials are especially helpful for people with esophageal cancer, as it is currently a cancer that is difficult to treat successfully.

Q: What's new in esophageal cancer research?

A: Cancer research should give you hope. Doctors and researchers around the world are learning more about what causes esophageal cancer, and are looking for and studying ways to prevent it. They are also finding better ways to detect and treat this disease.

Studies are being done to improve survival rates in people with esophageal cancer who are treated with various combinations of drugs. Newer radiation therapies may also prove to be helpful.